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Initial assessment
Initial assessment is an organized way to recognize and respond to life-threatening emergencies in a crisis. It can take from a few seconds to a minute, after which you either stay with the sick or injured person until further care arrives, or stay with them until both they and you agree it is o.k. for you to leave. Take a deep breath Imagine you find a friend or family member in medical distress or suddenly at a public gathering you find someone who injured or sick. What do you do? First of all, don't panic! Take a deep breath and think. The goals of your intervention should be: #Summon necessary resources to aid any victims (Police, Fire Department, Emergency Medical Services), and #Provide needed supportive assistance (CPR, bleeding control, spinal immobilization, traffic control, etc.) until more advanced help arrives, and #'Do not make the situation worse.' #'Avoid becoming an additional victim yourself.' Survey the scene As you approach victims, survey the scene: *Is it safe? * What could be dangerous? Look for things like: **potentially live electrical wires (Assume all wires are "live" until determined otherwise by fire department personnel.) **smell of flammable substances (gasoline, natural gas) **strong chemical odor ( ammonia, chlorine) **fire **weapons in the possession of or near victims **falling debris **unstable structure **advancing police **an out-of-control crowd **traffic *Can you get closer to possible victims without risk to yourself or others? *How many people need help? Eliminate or prepare for potential hazards to the injured or ill person, to yourself, and to bystanders. DO NOT BECOME A VICTIM YOURSELF! Use any crowd for moving obstacles, directing traffic, getting help, and keeping a safe space around injured people. Speaking in a calm voice will help keep others calm. Remember, most people want to help. Introduce yourself *"Hi, I'm so-and-so. I have some first aid training. Would you like me to help you? RESPECT THE VICTIM'S WISHES. Determine if the person is alert Determine their Level of Conciousness (LOC) by asking the quesions (be sure to phrase them so they require more than yes/no answers) *Person- "What's your name?" *Place- "Where are we?" *Time- *Event- "What happened to you?" If the person does not respond to normal conversation, shout and tap gently, but do not shake them, since this could make a neck or spine injury worse. Get their consent Ask the victim if he or she is willing to accept your help. If they don't want to talk to you or be touched by you, or whatever, do your best to find out why and attempt to get them help that they will accept. What you discover during the first part of initial assessment affects how you do the second part. When you surveyed the scene and determined if the person was alert, you probably got an idea of the mechanism of injury or illness (MOI) or the cause of the problem. Do you think the person fell? Were they in a fight? Do they appear to be under the influence of some stuff? Pay attention. The most important thing to consider before going on is: Based on the MOI, do you suspect a spinal injury? Check the ABCs This is a way to review the potential life-threats to a person before moving on to focus on one particular problem. Always assess and treat systems in their order of priority. A comes before B.... *Airway *Breathing *Circulation *Disability *Environment A-- is the Airway open? If the person talked to you normally, the airway is open. If they didn't talk, put your face next to theirs and look, listen, and feel for breathing for 15 seconds: *Look to see if their chest rises *Listen for sounds of breathing *Can you feel breath on your cheek? B-- is the person Breathing? If they can talk normally to you, they are breathing, right? If they didn't talk, and there seems to be no airway obstruction, but no breath is coming out or in, the problem might be with their breathing system. C-- is their Circulation compromised? The circulatory system is contained within the heart and blood vessels. If the person is breathing, their heart is beating. Don't waste time taking their pulse unless you know how. *Look for bleeding. Remember that bulky clothing, sand, or rocks might disguise blood loss. Blood loss may also be internal. Even if you find one bleeding injury, keep looking-- there may be other hidden injuries that are more severe. *If the victim is pale, cool, and clammy, and if s/he is becoming less alert, assume victim may be going into shock. D-- have they been Disabled? Any person who cannot think, move, or take care of themselves as they normally do-- or any person with a potential spinal injury-- is disabled. *Stay with them until they recover or help arrives. E-- have they suffered / will they suffer Exposure to a dangerous environment? While the environment in which you provide first aid might feel fine to you, pay attention to its effect on the sick or injured person. *Extremes of heat and cold can complicate any first aid, but cold exposure is more dangerous than heat. Any person with serious blood-loss, burns, or any injury that leaves them disabled needs to be kept warm and dry in all but the hottest of weather. *Exposure to fumes and chemicals are potentially life-threatening emergencies. Treat this type of exposure accordingly. Think of other environments which can seriously hurt an injured or sick person. Remember that the purpose of initial assessment is to discover threats to a person's life, and protect against those first, before providing general first aid. Document your care It is a good idea to keep notes about any problems you encounter in your initial assessment. Some medics put strips of adhesive tape on their pants and keep basic notes on it. Others write notes on the back side of protective gloves. They number their patients to maintain patient confidentiality, and take notes like this: :#1 :19yo F w/(L) leg wound :"patient reports being hit with projectile" :Pt A/Ox4 (Patient is alert and oriented by 4 knows name, location, day of week, year, etc., and what happened :A-- ok :B-- ok :C-- ok (minor bleeding (L) lower leg) ::HR elevated w/i normal range :D-- difficulty moving w/o assistance ::Pain 4 (out of 10) with pressure :E-- cold :Plan-- call 911, help her move inside, elevate leg, first aid. Many medics write their notes after they have completed initial assessment and basic first aid, so that they can give the person all their attention. Documentation is always important, and becomes more important the more assessment skills you know, and the longer the person will be in your care. Re-assess as needed Signs for some life-threats take a while to show up. Keep an eye on the person while they are in your care. If they can talk, have a conversation. Not only is it good for their morale, but you can quickly assess changes in their level of alertness. If the person's condition appears to change, assess again. Also, if you are going to be with the person a long time, assess them every few minutes, 15 minutes, hour, or few hours, depending on how injured or ill they are. Write down any changes for the better or worse. Notes It can be hard to tell what's wrong. Breathing problems may be due to asthma or anaphylaxis. Confusion could be due to diabetes, dehydration, psychological stress, or a head injury. Start from a place of love and respect, and harm none. This material is intended as a training supplement. Reading this material is no substitute for first aid / medical training with a qualified trainer. We encourage you to pursue ongoing education, reviewing and upgrading your skills-- for the safety of both yourself and anyone you treat. Category:Protocol